As spine technologies and patient safety become more advanced, practice leaders might consider adding cases normally done in hospital outpatient settings to the ASC. But Nikhil Shetty, MD, advised against rushing into the trend.
Dr. Shetty, COO of Munster, Ind.-based Midwest Interventional Spine Specialists, spoke about what ASC leaders should know about adding more spine procedures to their offerings.
Note: This conversation was lightly edited for clarity.
Question: What’s a big healthcare trend you’re following closely in 2026?
Dr. Nikhil Shetty: The biggest trend that I’m following is the migration of high acuity, complex cases traditionally done in an HOPD that are now being transitioned to the ASC and particularly ones owned and operated by physicians. That’s in the interventional spine and pain space. And in orthopedics and spine they’re doing outpatient lumbar fusions, outpatient cervical discs replacements and endoscopic spine surgeries, all done in the outpatient setting.
Patient safety makes that possible. Clinical improvements in technology make that possible. Familiarity with the settings, the workflow, environment and your staffing also makes that possible.
Another thing that makes it advantageous in the broader macroeconomic landscape is the overall spend. If you look at the reimbursements, or the total cost of procedures done in the HOPD and compare it to the ASC, it’s a significant difference. I’m a proponent of price transparency, and hopefully as site neutral payments become a thing, all of us Americans who buy our own health insurance become more in tune with this overall spend that’s happening.
Q: As an ASC leader, how are you evaluating whether an ASC is ready to take on these high acuity cases?
NS: Everybody looks at the reimbursement of an outpatient spinal fusion and wants to start incorporating that into a service line in their own ASC. What is even more important than that is to know what you’re good at. At the ASC that we run in northwest Indiana, we’ve been doing interventional spine and pain procedures for a little over 10 years. We’ve become very proficient as clinicians and nurse practitioners. Our clinical staff in the ASC, the nursing staff, the operating nurse and our pre-op and post-op areas become very in tune with managing and caring for interventional pain patients and the types of procedures that we do.
As we grow our proficiency in that space we try and maximize what we can do while staying within our wheelhouse. I think sometimes ASC leaders get into trouble when they want to incorporate a new service line for something that their staff is not necessarily capable of handling. We’re very well aware of what we are proficient at, and we like to stay within our wheelhouse specifically with interventional pain and maximizing our outcomes. I want to do the best job I can for my interventional pain patients, and the same mindset is disseminated across my staff in our ASC and our office space.
